Ambulance services concerned about insurance billing practices

Times Staff/ROBERT J. GURECKI. A crowd of ambulance squad staff members squeezed into the Boothwyn Fire Company to voice their grievances about lack of direct insurance reimbursement when picking up patients.

UPPER CHICHESTER — Emergency medical technicians working in a handful of Delaware County fire departments are urging state legislators to make it easier for first responders to collect payment for their services

About 20 EMTs gathered at Boothwyn Fire Company on Thursday night to explain the problem their ambulance services are having with collecting payment from patients they transport to area hospitals. The currently convoluted payment process is costing them tens of thousands of dollars a year, they said.

As it stands, an ambulance service is legally required to respond to an emergency call when dispatched. After taking a sick or injured person to the hospital, the service then bills the patient’s insurance company. This is where things get tricky. If the insurance company approves the charges, they will send a check to the patient. The check is made out in the patient’s name, and then it is up to the patient whether or not they make a payment to the ambulance company. This system is rife with fraud, according to Jason Heacock, an EMT with Boothwyn Fire Company with more than 20 years of experience.

“The payment gets sent directly to the patient,” Heacock said. “It’s such a problem that Boothwyn Fire Company loses between $70,000 and $90,000 per year.”

A bill to rectify this collection problem has been floating around the Pennsylvania legislature for more than a decade, according to state Rep. Stephen Barrar, R-160, of Upper Chichester. Barrar, who has served as chairman of the House Committee on Veterans Affairs and Emergency Preparedness for four years, said that powerful lobbyists for the insurance industry have blocked the passage of this legislation over the years. HB 179, its current iteration, was reintroduced in January and is currently tabled in Barrar’s committee.

“This bill has probably been around for maybe 12 or even 16 years,” Barrar, a co-sponsor of HB 179, said during the meeting Thursday. “(The insurance companies) just refuse to join us. Their thought is that the ambulance companies should join their networks.”

The problem ambulance companies have with joining insurance networks is that the reimbursement rate is entirely too low to sustain operations, according to Heacock. As it stands now, an ambulance company can only bill a patient if they are transported to the hospital. Any treatment provided on scene to non-transported patients can’t be billed, Heacock said.

“If we join the network, we have to agree to accept cut rate payments as low as $200,” Heacock said. With two full-time employees and about 20 part-timers, annual payroll for Boothwyn’s ambulance service is about $250,000. They have to incorporate costs incurred while treating non-transported patients into the bills for transported patients. When they don’t receive payments, they lose money spent on both types of calls.

“The biggest frustration we have is that it is so elementary and it makes so much sense (to pass this bill),” Heacock said.

Boothwyn’s billing company, DMMS of Newark, Del., has been pursuing the people who keep the insurance checks, but there is little recourse available to them.

“We were tracking a patient that was embezzling money that belonged to Boothwyn Fire Company,” Keith Bowman from DMMS said. “We were able to go back over information to prove that this woman had embezzled $23,000 from the fire company.”

Bowman said that after the fire company filed civil charges in court, full payment was made over a period of about a year, but that court relief is dependent on the patient showing up to the proceedings.

“We don’t have time for that,” Heacock said. “Now we have to chase down criminals that take our money.”

Barrar said the problems aren’t just limited to Delaware County. He said that Philadelphia has lost more than $20 million this way. Bowman, whose company also does billing in Delaware, New Jersey and Maryland, said that this problem is the worst in Pennsylvania, but is quickly spreading to the other states.

“We are seeing patients who are smart enough to figure out that this is a way to make easy money,” Heacock said. Even if a patient refuses to pay multiple times, the ambulance still has to respond when dispatched.

“If you’re a customer of mine and you’ve cheated me out of 15 payments, I’m not going to answer your calls,” Barrar said. But for Boothwyn Fire Company and others in the county, that is not an option.

“We need this money to operate right now,” Heacock said, explaining that of the 1,800 patients the fire company transports each year, they only collect about 60 percent of the bills. “It’s a quality of life issue for the people of the community.”

A representative for state Sen. Dominic F. Pileggi, R-9, of Chester, was also present at the meeting. The bill has had very little success in the state senate over the years, and Pileggi’s chief of staff, Darren Smith, said that he would relay all of the information gathered at the meeting to the senator.

“We appreciate all of the work you do,” Smith said to the gathered EMTs.